Nutritional therapy for critically critically ill COVID-19 patients

© 2020 by Turkish Society of Medical and Surgical Intensive Care Medicine.The world has experienced coronavirus disease 2019 (COVID-19) which is a pandemic and a public health crisis worldwide. It primarily affects the respiratory tract and associated with serious morbidity and mortality. There are currently no proven drug in COVID-19 patients. The main treatment of COVID-19 are supportive treatments. Nutrition therapy remains one of the cornerstone treatments for these patients. ASPEN (4) and ESPEN (5) nutrition guidelines for COVID-19 patients were compiled and this framework was created for the purpose of nutritional management in COVID-19. Considering that respiratory secretion of these patients poses a risk of contamination for healthcare professionals, recommendations have been prepared. These recommendations include effective nutritional management for COVID-19 patients, with the principle of entering the patient room as little as possible and intervening as little as possible

Effects of Ramadan fasting on lean body mass in the older people

Key summary pointsAim The purpose of this study was to evaluate the physiological effects of Ramadan fasting on muscle function and muscle mass in the older people. Findings We found that body weight and composition were not influenced by Ramadan fasting in both females and males. Message Ramadan fasting supplied no risk for muscle function and muscle mass in the older people

Prevalence of malnutrition diagnosed by the Global Leadership Initiative on Malnutrition and Mini Nutritional Assessment in older adult outpatients and comparison between the Global Leadership Initiative on Malnutrition and Mini Nutritional Assessment energy-protein intake: A cross-sectional study

Background The Global Leadership Initiative on Malnutrition (GLIM) published malnutrition identification criteria. The Mini Nutritional Assessment (MNA) is malnutrition assessment tool commonly used in older adults. This study aimed to determine prevalence of malnutrition and the relationship between the GLIM and the MNA long form (MNA-LF) and short form (MNA-SF) and energy-protein intake

Evaluation of refeeding hypophosphatemia frequency, risk factors, and nutritional status during stem cell transplantation in patients with hematologic malignancy

© 2022 European Society for Clinical Nutrition and MetabolismBackground: Refeeding Hypophosphatemia (RH) occurs with feeding after an extended period of not feeding. Hematological Stem Cell Transplantation (HSCT) is one of the effective methods for hematologic malignancy. Nutritional disorders are frequently observed in hematologic malignancies due to the disease's pathology and the treatment's effect. The study aims to determine the influencing factors by determining the frequency of RH in patients treated with HSCT. Methods: The study was conducted prospectively and randomly with 50 patients treated with HSCT for the first time. The study followed patients for 22 days, seven days before, and 14 days after. During the follow-up, data such as Scored Patient-Generated Subjective Global Assessment (PG-SGA), weight changes, nausea, vomiting, diarrhea, mucositis, infection and Graft Versus Host Disease development, need for intensive care, and 12-month mortality were recorded. RH states were evaluated during treatment. Results: RH developed in 78% of patients treated with HSCT. Pre-transplantation PGSGA score, frequency of vomiting, and development of infection were higher in patients with RH (p < 0.05). The patients had a mean weight loss of 2.9% after transplantation. Pre-transplantation, 88% of patients were well-nourished (PGSGA 0–3), post-transplantation, 70% of patients were moderately undernourished (PGSGA 4–8), and 30% were severely malnourished (PGSGA ≥ 9). While total protein and albumin decreased after transplantation, CRP increased (p < 0.05). According to multivariate logistic regression analysis, infection (95% CI: 1.375–61.379, p = 0.022) and pre-transplant PGSGA (95% CI: 1.035–45.454, p = 0.046) independently affect RH development. Conclusions: RH was detected at a high rate in patients treated with HSCT. Elevated risk of malnutrition before transplantation, frequency of vomiting, and development of infection were determined as factors affecting RH development

Importance of Asprosin for Changes of M. Rectus Femoris Area during the Acute Phase of Medical Critical Illness: A Prospective Observational Study

Asprosin, a new adipokine, is secreted by subcutaneous white adipose tissue and causes rapid glucose release. The skeletal muscle mass gradually diminishes with aging. The combination of decreased skeletal muscle mass and critical illness may cause poor clinical outcomes in critically ill older adults. To determine the relationship between the serum asprosin level, fat-free mass, and nutritional status of critically ill older adult patients, critically ill patients over the age of 65 receiving enteral nutrition via feeding tube were included in the study. The patients’ cross-sectional area of the rectus femoris (RF) of the lower extremity quadriceps muscle was evaluated by serial measurements. The mean age of the patients was 72 ± 6 years. The median (IQR) serum asprosin level was 31.8 (27.4–38.1) ng/mL on the first study day and 26.1 (23.4–32.3) ng/mL on the fourth study day. Serum asprosin level was high in 96% of the patients on the first day, and it was high in 74% on the fourth day after initiation of enteral feeding. The patients achieved 65.9 ± 34.1% of the daily energy requirement for four study days. A significant moderate correlation between delta serum asprosin level and delta RF was found (Rho = −0.369, p = 0.013). In critically ill older adult patients, a significant negative correlation was determined between serum asprosin level with energy adequacy and lean muscle mass

Frequency and Related Risk Factors of Refeeding Hypophosphatemia in Patients with Liver Cirrhosis: A Pilot Study.

Background & Aims: Refeeding hypophosphataemia (RH) is associated with poor clinical outcomes and mortality rates. However, the presence of RH in patients with cirrhosis remains unknown. This study aimed to determine the relationship among the frequency of RH, nutritional status, and disease severity in patients with liver cirrhosis.Methods: This prospective study was conducted at a single-centre gastroenterology clinic. Malnutrition was identified using the Subjective Global Assessment (SGA). Disease severity was defined using the ChildTurcotte-Pugh (CTP) and the Model for End-Stage Liver Disease (MELD) scores. Hypophosphatemia was defined as a serum phosphate level of <2.0 mg/dL.Results: Twelve of 50 cirrhotic patients (24%) had RH during hospitalization. The most common RH was determined in four patients on day four during the study follow-up. The sharpest decline in serum phosphate levels was observed on day four (median: 2.3 mg/dL). The CTP score and MELD scores did not differ significantly between RH and non-RH groups ((p=0.478 and p=0.643), respectively. The rate of malnutrition according to the SGA was 56.0%. A total of 82%, 4%, 8%, and 4% of participants received regular diet and oral nutritional supplements, only enteral tube feeding, only parenteral nutrition, and combined enteral and parenteral nutrition, respectively. In the RH group, 32% of participants received only parenteral nutrition and had a higher prevalence of RH than that of patients receiving only oral or enteral tube feeding (p=0.001). The CTP score strongly and negatively correlated with serum phosphorus levels on days two (p=0.016), three (p=0.050), and seven (p=0.017) in the RH group.Conclusions: This study showed that artificial feeding (enteral or parenteral nutrition) carries a significant risk in terms of RH. Malnourished patients with liver cirrhosis who received parenteral nutrition were closely monitored for a high risk of RH. The CTP score strongly and negatively correlated with serum phosphorus levels

Wernicke's Encephalopathy: A Forgotton Disease

Wernicke's encephalopathy (WE) is an acute neurological condition characterized by ataxia, confusion, ocular findings, and impairment of consciousness due to thiamine deficiency. Although alcoholism is the most common reason, WE cases resulting from prolonged total parenteral nutrition (TPN) without multivitamin complex have been reported. Here we present a dramatic improvement in symptoms with high-dose thiamine in a patient who developed WE due to TPN after gastrointestinal surgery

Serum trace elements levels in patients transferred from the intensive care unit to wards.

Background & aims: Trace elements act as co-factors and/or in co-enzymes in many metabolic pathways and its deficiency contributes to metabolic and infectious complications. The aim of this study was to determine serum zinc, selenium, cobalt, chromium, copper and ceruloplasmin levels for identify the need for post intensive care unit (ICU) nutritional follow-up

Enteral nutrition interruptions in critically ill patients: A prospective study on reasons, frequency and duration of interruptions of nutritional support during ICU stay

© 2022 European Society for Clinical Nutrition and MetabolismBackground & aims: Enteral Nutrition (EN) may be interrupted due to various reasons in the setting of intensive care unit (ICU) care. This study aimed to investigate the reasons, frequency, and duration of EN interruptions in critically ill patients within the first 7 days of ICU stay. Methods: A total of 122 critically ill patients (median age: 63 years, 57% were males) initiating EN within the first 72 h of ICU admission and continued EN for at least 48 h during ICU stay were included in this observational prospective study conducted at a Medical ICU. Patients were followed for hourly energy intake as well as the frequency, reason, and duration of EN interruptions, for the first seven nutrition days of ICU stay or until death/discharge from ICU. Results: The median APACHE II score was 22 (IQR, 17–27). The per patient EN interruption frequency was 2.74 and the median total EN interruption duration was 960 (IQR, 105–1950) minutes. The most common reason for EN interruption was radiological procedures (91 episodes) and the longest duration of EN interruption was due to tube malfunctions (1230 min). Target energy intake were achieved on the 6th day at a maximum rate of 89.4%. Logistic regression showed that there was relationship between increased mortality and patients with ≥3 EN interruptions (OR: 6.73 (2.15–30.55), p = 0.004) after adjusting for confounding variables (age and APACHE II score). According to Kaplan Meier analysis, patients with ≥3 EN interruptions had significantly lower median survival times than patients with <3 EN interruptions (24.0 (95% CI 8.5–39.5) vs 18.0 (95% CI 13–23) days, p = 0.014). Conclusion: During the first week of EN support, the most common reason of EN interruptions was related to radiological procedures and the longest EN interruptions was due to feeding tube malfunctions. There was relationship between ≥3 EN interruptions and increased mortality